Community-acquired pneumonia — KFP-style written assessment

KFP 1 (10 marks)

A 68-year-old man presents with three days of productive cough, fever 38.5°C, and increasing breathlessness. On examination: respiratory rate 26, BP 118/70, SpO2 93% on air, crackles at the right base. CXR confirms right lower lobe consolidation. Urea 6.5 mmol/L. No confusion. ^[2]

1. Calculate his CURB-65 score. (3) ^[1]
2. What is the appropriate disposition? (2) ^[1]
3. What empiric antibiotic regimen would you start? (3) ^[3]
4. What does the CDC aetiology study suggest about the likely pathogen? (2) ^[2]

Model answers

1. CURB-65 = 1. Confusion: absent (0). Urea 6.5 below 7 (0). Respiratory rate 26 below 30 (0). Systolic BP 118 above 90 (0). Age 68 above 65 (1 point). Total = 1. ^[1]
2. Score 0-1: manage at home with oral antibiotics and safety-netting advice. His SpO2 93% is borderline but acceptable for community management. ^[1]
3. Oral amoxicillin 500 mg-1 g three times daily (or doxycycline 100 mg twice daily if penicillin-allergic). Review at 48 hours to confirm improvement. ^[3]
4. The CDC study found viruses were the commonest identified pathogens (rhinovirus 9%, influenza 6%) followed by S. pneumoniae (5%). A pathogen was detected in only 38% — most cases are treated empirically. ^[2]